Organization
JENNICA LAINE-FORMISANO PSYD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNICA LAINE-FORMISANO PSYD (OWNER)
(845) 489-3687
Entity
Organization
Contact information
Practice address
260 KINGS MALL CT # 331, KINGSTON, NY 12401-1574
(845) 489-3687
(845) 332-6041
Mailing address
260 KINGS MALL CT # 331, KINGSTON, NY 12401-1574
(845) 489-3687
(845) 332-6041
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/27/2022
Last updated
05/27/2022
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